ECT/TMS

Question 1

Which is associated w/ worsened retrograde amnesia during ECT? (5x)

Answer 1

BILATERAL ELECTRODE PLACEMENT

Question 2

47y/o pt w acute mania is unresponsive to pharmacotx. Pt’s current med regimen includes lithium, divalproex, clonazepam, olanzapine, bupropion. ECT is begun, pt is continued on previous med regimen. After 2 ECT tx, pt becomes delirious. Cause? (x3)

Answer 2

LITHIUM

Question 3

Which med should be held before ECT? (x3)

Answer 3

LITHIUM

Question 4

Most important potential side effect of ECT to discuss with 78 yo patient (2x)

Answer 4

COGNITIVE DYSFUNCTION

Question 5

Pt w/ hx of melancholic depression is severely dehydrated, emaciated, and catatonic. He began withdrawing, talking about death, stopped eating and drinking and lost 20lbs. Tx of choice? (x2)

Answer 5

ELECTROCONVULSIVE THERAPY (ECT)

Question 6

What is associated with a markedly increased risk of complications from ECT? (x2)

Answer 6

COPD

Question 7

Transcranial magnetic stimulation for Tx of depression targets which brain regions? (X2)

Answer 7

PREFRONTAL CORTEX

Question 8

What medical condition has highest relative risk for adverse event with ECT?

Answer 8

CONGESTIVE HEART FAILURE

Question 9

The ability of magnetic seizure therapy to target specific brain regions implicated in depression gives it what potential advantage, compared with traditional ECT:

Answer 9

FEWER COGNITIVE SIDE EFFECTS

Question 10

58 y/o with MDD is getting ECT, develops dense retrograde amnesia after 3rd treatment. How can this be ameliorated?

Answer 10

INCREASING THE INTERVAL BETWEEN ECT TREATMENTS

Question 11

Pt has not responded to adequate trials of SSRI, SNRI, TCA, MAOI, but feels improved with 8 treatments of ECT. What next?

Answer 11

CONTINUE MAINTENANCE ECT FOR AT LEAST 10 WEEKS

Question 12

Deep brain stimulation targeting what area of the brain is most studied for treatment of depression

Answer 12

SUBCALLOSAL CINGULATE CORTEX

Question 13

Most serious side effect of rTMS

Answer 13

SEIZURES

Question 14

What barbiturate is used in ECT to produce a light coma?

Answer 14

METHOHEXITAL

Question 15

Greatest risk of death w/ ECT:

Answer 15

RECENT MI

Question 16

Indication for treating a manic w/ ECT:

Answer 16

DANGEROUS LEVELS OF EXHAUSTION

Question 17

Prophylactic Treatment for a pt with severe delusional depression following a course of ECT includes what?

Answer 17

COMBINATION OF ANTIPSYCHOTICS AND ANTIDEPRESSANTS

Question 18

ECT is least likely to be effective for patients who have?

Answer 18

CHRONIC SCHIZOPHRENIA

Question 19

What condition is a relative contraindication to ECT?

Answer 19

CARDIAC ARRYTHMIA

Question 20

A 70 y/o patient presents with severe psychotic depression. Patient stopped eating and speaks very little. Failed multiple med trials. What’s next?

Answer 20

ECT

Question 21

Psych MD is counseling a pt about risks and benefits of ECT. What statement correctly describes the risk of cognitive impairment?

Answer 21

HIGH DOSE UNILATERAL ELECTRODE REPLACEMENT IS ASSOCIATED WITH LESS COGNITIVE IMPAIRMENT.

Question 22

Med that is assoc w prolonged seizures/confusional state during ECT:

Answer 22

LITHIUM

Question 23

Which medication should be discontinued prior to ECT?

Answer 23

BUPROPION

Question 24

What eeg read Correlates to a positive response to ECT?

Answer 24

INCREASED ECT-INDUCED FRONTAL DELTA ACTIVITY

Question 25

TMS advantages over ECT

Answer 25

LACK OF ANESTHESIA

Question 26

Most commonly limits the use of ECT:

Answer 26

COGNITIVE IMPAIRMENT